Respect for physicians

[discharged]

Just wanted to vent about current state of, say.. the reverence of physicians? I feel like politicians/lawyers, insurance companies, press ganey, etc., are doing everything within their powers to diminish the authority and reputation of physicians.. to the point where the public views us as self-centered, quibbling, uneducated-in-comparison-to-google-search-medicine, and undeserving/overpaid thieves.

It's no secret that America reveres the celebrities/athletes and would rather shed money to be within a mile of them than to pay for gas for the services of a physician. Although reports say they are slightly less respected, I think priests are still held in a much higher regard than us- even taking all of the scandals into account. I mean, people still kneel before them, kiss their hands, and hand them weekly checks.. (not saying that's what I want, just making a point).

Sad to think, but in the back of my mind, I feel like our compassion has left us vulnerable in society. Unlike the esteemed figures mentioned, they don't have to please people. Also, we don't get theatrics during our appearances. People no longer stand up when a physician enters the room. Instead of baked goods, we receive subpoenas and constant reminders to get our act straight by hospital administrators. Patients take what we say with a grain of salt. They are making demands on their care as if we are just a third party obstacle...

It's depressing that we must come to work with a protect-yourselves-at-all-times attitude, instead of enjoying work and practicing the best medicine that we have devoted our lives training for. Where have we gone wrong?.. As a profession, where are we heading?.. How low can we go?..

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[SoyMilk]

Just wanted to vent about current state of, say.. the reverence of physicians? I feel like politicians/lawyers, insurance companies, press ganey, etc., are doing everything within their powers to diminish the authority and reputation of physicians.. to the point where the public views us as self-centered, quibbling, uneducated-in-comparison-to-google-search-medicine, and undeserving/overpaid thieves.

It's no secret that America reveres the celebrities/athletes and would rather shed money to be within a mile of them than to pay for gas for the services of a physician. Although reports say they are slightly less respected, I think priests are still held in a much higher regard than us- even taking all of the scandals into account. I mean, people still kneel before them, kiss their hands, and hand them weekly checks.. (not saying that's what I want, just making a point).

Sad to think, but in the back of my mind, I feel like our compassion has left us vulnerable in society. Unlike the esteemed figures mentioned, they don't have to please people. Also, we don't get theatrics during our appearances. People no longer stand up when a physician enters the room. Instead of baked goods, we receive subpoenas and constant reminders to get our act straight by hospital administrators. Patients take what we say with a grain of salt. They are making demands on their care as if we are just a third party obstacle...

It's depressing that we must come to work with a protect-yourselves-at-all-times attitude, instead of enjoying work and practicing the best medicine that we have devoted our lives training for. Where have we gone wrong?.. As a profession, where are we heading?.. How low can we go?..

Must have been a rough day

 

[discharged]

vending machine ripped me off 😡

 

[SoyMilk]

vending machine ripped me off 😡

So do you regret entering EM?

-an MS3

 

[discharged]

Nah, I'm speaking about the profession of medicine as a whole. At the end of the day, I still couldn't see myself doing anything else. EM is a great field that is continuing to grow. I just find it fascinating much of a descent our reputation has taken in the past decade.

 

[SoyMilk]

Nah, I'm speaking about the profession of medicine as a whole. At the end of the day, I still couldn't see myself doing anything else. EM is a great field that is continuing to grow. I just find it fascinating much of a descent our reputation has taken in the past decade.

What do you think about the reputation of EM physicians specifically as you interact to other physicians, to patients, or to the general public. I hate how everyone in my class (still students) dump on EM. It's annoying since it's what I want to do.

 

[Akail]

What do you think about the reputation of EM physicians specifically as you interact to other physicians, to patients, or to the general public. I hate how everyone in my class (still students) dump on EM. It's annoying since it's what I want to do.

Pretty sure OP is a matched MS4...

 

[discharged]

Pretty sure OP is a matched MS4...

Today was my last day on rotation, so officially... Who am I kidding, I'm still a matched MS4

 

[discharged]

What do you think about the reputation of EM physicians specifically as you interact to other physicians, to patients, or to the general public. I hate how everyone in my class (still students) dump on EM. It's annoying since it's what I want to do.

I'll reiterate, my original post was just venting from an article my attending handed me bashing on physicians, not specifically emergency medicine physicians. No matter what field you decide to enter, everyone is always going to have something negative to say about your specialty. I wouldn't let it deter you and choose what you enjoy doing.

 

[KLPM]

Sad to think, but in the back of my mind, I feel like our compassion has left us vulnerable in society. Unlike the esteemed figures mentioned, they don't have to please people. Also, we don't get theatrics during our appearances. People no longer stand up when a physician enters the room. Instead of baked goods, we receive subpoenas and constant reminders to get our act straight by hospital administrators. Patients take what we say with a grain of salt. They are making demands on their care as if we are just a third party obstacle...

I know a lot of doctors who work in rural areas that get a lot of respect. Try doing that?

After entering medical school a few years ago I have realised that I care little for respect from patients. Patients have plenty of misconceptions about doctors do. Patients have plenty of expectations that are impossible to achieve. I just want to be able to do my job and do it well.

My intellectual interests far precede my desire to receive standing ovations every time I see a patient. As for baked goods, well you can never be too sure what's in those so I had stay well away from that. If you want respect make sure you are good at what you do because you will certainly not get any if you don't.

As for patients taking what we say with a grain of salt, that's not necessarily a bad thing. We no longer employ a paternalistic health care model, at least we try not to think we are, and instead encourage patients to participate in their own health care. They are the ones who are sick after all. Although I agree for some patient groups we probably are just third party obstacles (e.g. drug seekers).

 

[RustedFox]

Disclaimer: Didn't read the whole thread.

I find that "respect" and "appreciation" are largely a function of the age of my patients. The 50+ crowd gives me hugs and offers to have me for dinner. The 30 and below crowd act like I'm a particularly bad waiter and are 'entitled" to everything and then some under the sun.

 

[joeDO2]

Yes, sadly it seems physicians see very little respect from both patients and department staff. It seems most patients come with a particular goal in mind..."stitch me up" or "give me pain meds" or "I need a CT scan". They aren't looking for your expert opinion/consultation, they are looking for you to carry out a service related task which they feel they know just as much about from the info on google.
As far as the staff...in more than one ED I have seen the following scenarios play out:
Doc: "hey can you give a liter of fluid in room 3"
Nurse: "uhhh nah, I think I'm gonna hold off for now I don't think they need it"
or
Nurse: "I decided to give some toradol in room 4, I need you to put an order in for 30mg"
Doc: "ok I guess"
It seems like in many cases the docs are seen as an obstacle / someone the nurses need to sign off on the paperwork.

 

[deleted480308]

I'm going into medicine from 10years as clergy.....don't expect a ton of deference in either field. If you choose a field because people should "stand when you enter the room", your life will be full of disappointments. Do what you like to do and be good at it, you'll need to provide your own self-esteem because other people are a poor source of it

 

[Birdstrike]

Just wanted to vent about current state of, say.. the reverence of physicians? I feel like politicians/lawyers, insurance companies, press ganey, etc., are doing everything within their powers to diminish the authority and reputation of physicians.. to the point where the public views us as self-centered, quibbling, uneducated-in-comparison-to-google-search-medicine, and undeserving/overpaid thieves.

It's no secret that America reveres the celebrities/athletes and would rather shed money to be within a mile of them than to pay for gas for the services of a physician. Although reports say they are slightly less respected, I think priests are still held in a much higher regard than us- even taking all of the scandals into account. I mean, people still kneel before them, kiss their hands, and hand them weekly checks.. (not saying that's what I want, just making a point).

Sad to think, but in the back of my mind, I feel like our compassion has left us vulnerable in society. Unlike the esteemed figures mentioned, they don't have to please people. Also, we don't get theatrics during our appearances. People no longer stand up when a physician enters the room. Instead of baked goods, we receive subpoenas and constant reminders to get our act straight by hospital administrators. Patients take what we say with a grain of salt. They are making demands on their care as if we are just a third party obstacle...

It's depressing that we must come to work with a protect-yourselves-at-all-times attitude, instead of enjoying work and practicing the best medicine that we have devoted our lives training for. Where have we gone wrong?.. As a profession, where are we heading?.. How low can we go?..

Don't confuse "reverence" with "respect". Doctors are greatly "respected". Tony Soprano and Al Capone were also respected (yet not quite "revered".) The word you are looking for is resented. It's a "greed and envy" thing; class warfare. You're seen as "rich and greedy," one of the "one percenters". If you don't believe me, reference "Married to Medicine," the TV show. It's a sign o' the times.

That's you, and me.

Golden Age of Medicine: Marcus Welby. Stone Age of Medicine: Married to Medicine. Then you've got doctor Oz going on TV and telling the public it's all true, while he takes in 100 times what you do. Hmm...

I wrote a long post about this on a different SDN EM thread a while back (you might have read it). EP Monthly ended up putting it on their blog (White Coats call room) and so did Kevin Pho on his ( KevinMD.com). It sums up my thoughts on this. Rather than repeat myself I'll post a link to it. The best part about the post by far is not my post, but the comments at the end from non-physicians:

http://www.kevinmd.com/blog/2012/10/patients-resent-greedy-doctors.html

So to answer you question, how not to get depressed over it: do it for yourself, your family and because you need a job. It's a good job, and you'll do very well. Don't do it for "respect" or "reverence." If you do so, you will be continually disappointed. If you want reverence, go into acting or....



...learn how to dunk with your tongue hanging out.

 

[EM2013]

Don't confuse "reverence" with "respect". Doctors are greatly "respected". Tony Soprano and Al Capone were also respected (yet not quite "revered".) The word you are looking for is resented. It's a "greed and envy" thing; class warfare. You're seen as "rich and greedy," one of the "one percenters". If you don't believe me, reference "Married to Medicine," the TV show. It's a sign o' the times.

That's you, and me.

Golden Age of Medicine: Marcus Welby. Stone Age of Medicine: Married to Medicine. Then you've got doctor Oz going on TV and telling the public it's all true, while he takes in 100 times what you do. Hmm...

I wrote a long post about this on a different SDN EM thread a while back (you might have read it). EP Monthly ended up putting it on their blog (White Coats call room) and so did Kevin Pho on his ( KevinMD.com). It sums up my thoughts on this. Rather than repeat myself I'll post a link to it. The best part about the post by far is not my post, but the comments at the end from non-physicians:

http://www.kevinmd.com/blog/2012/10/patients-resent-greedy-doctors.html

So to answer you question, how not to get depressed over it: do it for yourself, your family and because you need a job. It's a good job, and you'll do very well. Don't do it for "respect" or "reverence." If you do so, you will be continually disappointed. If you want reverence, go into acting or....



...learn how to dunk with your tongue hanging out.

So not surprised by any of this. The reasons for this have been summarized already but I'll say them again:

1) The ME Generation (Sadly my own generation) aka anyone currently 20-35 yo. These people want what they want when they want it, and as others have said, view physicians as bureaucrats standing in their way to achieving their endgame. This is rampant all throughout medicine - not just in the ED. I've seen it on the medicine floors, on the peds floors, etc.

2) The internet. Seriously, I'm all on board with patients being empowered and knowing what's going on with their own body but if you're going to come into the ED citing some article on msnbc or news story on CNN as the gospel truth then wtf are you doing here seeking my services to begin with? I have a relative who is an elementary school science teacher and does a lot of "reading" whom the rest of my family is more inclined to ask their medical questions rather than myself (graduating MS4 going into EM) or the R.N. in the family. This might actually be a blessing in disguise though because I really don't want to spend my Thanksgivings fielding "Hey what do you think about this rash?" questions.

Yes, sadly it seems physicians see very little respect from both patients and department staff. It seems most patients come with a particular goal in mind..."stitch me up" or "give me pain meds" or "I need a CT scan". They aren't looking for your expert opinion/consultation, they are looking for you to carry out a service related task which they feel they know just as much about from the info on google.
As far as the staff...in more than one ED I have seen the following scenarios play out:
Doc: "hey can you give a liter of fluid in room 3"
Nurse: "uhhh nah, I think I'm gonna hold off for now I don't think they need it"
or
Nurse: "I decided to give some toradol in room 4, I need you to put an order in for 30mg"
Doc: "ok I guess"
It seems like in many cases the docs are seen as an obstacle / someone the nurses need to sign off on the paperwork.

A question to current residents and attendings: How do you deal with this?

 

[FSU2013]

My take on the matter is this: The time where doctors were revered has passed and may be gone forever. They/we will always be respected by decent, respectable people and will fail to be respected by the people who don't have respect for themselves. But while battling decreasing compensation and overregulation from the national government, EMR/CPOE, lack of support from hospital admin, Dr. Oz telling patient's not to take their antibiotics, midlevel creep, etc. we have to realize that we have to pick our battles. It only takes a motivated, skilled subset of the MD community to battle the government or hospital admin; it takes the entire community of MDs to recover reverence and, to some extent, respect. So long as there are MDs who don't "get it" and are willing to put their own personal gain above the profession, we won't have that same respect of old from every single patient. Personally, I'm more concerned with government regulation/compensation/midlevels. Maybe that's just me. What do I know, I, too, and just a matched MS4.

 

[discharged]

My question is, what are we doing/not doing that is causing our profession's status to dwindle? I think Ben Carson's solution is a start, to have physicians back in the government.. how can we undo what has been done if we are in no position to make that call?

 

[Birdstrike]

My question is, what are we doing/not doing that is causing our profession's status to dwindle? I think Ben Carson's solution is a start, to have physicians back in the government.. how can we undo what has been done if we are in no position to make that call?

This is much greater than any of us. It's our entire society, culture and progression of human nature. All anyone cares about is money, fame and power. It's the fall of Rome. It's happened before; it'll happen again. Some of these things are pre-destined and beyond our control. All you can do is pick what part you want to play. Then sit back and watch the play unfold.


Act I

Act II

Act III


The End.

 

[24IdaFire]

As far as the staff...in more than one ED I have seen the following scenarios play out:
Doc: "hey can you give a liter of fluid in room 3"
Nurse: "uhhh nah, I think I'm gonna hold off for now I don't think they need it"
or
Nurse: "I decided to give some toradol in room 4, I need you to put an order in for 30mg"
Doc: "ok I guess"
It seems like in many cases the docs are seen as an obstacle / someone the nurses need to sign off on the paperwork.

A question to current residents and attendings: How do you deal with this?

We had a problem with staff pre-medicating folks before a doctor saw them in the past. Culminated with a nurse starting a nitro drip before a ED physician saw them. After that the axe fell and the problem has resolved.

 

[Beargryllz]

Do Doctors Without Borders. Everyone seems to have mad respect for them.

 

[Hercules]

We had a problem with staff pre-medicating folks before a doctor saw them in the past. Culminated with a nurse starting a nitro drip before a ED physician saw them. After that the axe fell and the problem has resolved.

But this could lead to new problems of delayed care and dispositions, increased wait times and lack of ED beds when you need them.

A nitro drip or ordering an MR might be premature, but I actually want the nurses ordering labs and X-rays before I see the patient any time we are busy. There should be standing orders approved by the docs to accomplish this in any mildly efficient ED. Do any of us really think we need to see the 80 YO chest pain with multiple stents before they get their ASA , EKG, CXR, and lab work ordered?

 

[deleted206819]

Our nurses have standing orders for aspirin, EKG, labs but not XR, CT, or MRI and I don't want them to go beyond that. When they take a patient's history at the bedside it is not similar to our history taking and their differential is off by a mile and shotgun labs to that effect. Most of the nurses I work with are awesome but I'm not sure that I want them to start dictating the work-ups, pain management, and other elements of care to us.

 

[GeneralVeers]

I used to buy into the physician respect attitude and used to resent the patients for it. It caused a lot of stress on my job and at home. Then I had an epiphany. I realized that if I act how the hospital admin and the large Contract Management Groups think of physicians, my life would get easier.

I realized that I am a replaceable cog in the machine. I am just a contractor required to a do a specific job for a specific number of hours. The patients are just "widgets" that I must move through the system during my scheduled hours. As a result I show up on time for my shift, move patients through my algorithm with the minimal amount of chitchat, stop seeing patients an hour before my shift and go home. I realized that there is no recognition anymore for going above and beyond, for staying after my shift, or for spending that extra 10 minutes comforting some lonely grandmother. It may sound depressing, but it's actually been a release. I don't stress about the hospital throughput issues which I can't control, and I go home on time, have a drink, and completely forget about anything work-related. The hospital doesn't want my services anymore? Great, there are hundreds of others looking for replaceable cog-physicians to move their widgets.

 

[Birdstrike]

I used to buy into the physician respect attitude and used to resent the patients for it. It caused a lot of stress on my job and at home. Then I had an epiphany. I realized that if I act how the hospital admin and the large Contract Management Groups think of physicians, my life would get easier.

I realized that I am a replaceable cog in the machine. I am just a contractor required to a do a specific job for a specific number of hours. The patients are just "widgets" that I must move through the system during my scheduled hours. As a result I show up on time for my shift, move patients through my algorithm with the minimal amount of chitchat, stop seeing patients an hour before my shift and go home. I realized that there is no recognition anymore for going above and beyond, for staying after my shift, or for spending that extra 10 minutes comforting some lonely grandmother. It may sound depressing, but it's actually been a release. I don't stress about the hospital throughput issues which I can't control, and I go home on time, have a drink, and completely forget about anything work-related. The hospital doesn't want my services anymore? Great, there are hundreds of others looking for replaceable cog-physicians to move their widgets.

Punch in.

See 2 patients per hour (no saving the world).

Punch out (always on time).

Home.


Rinse, and repeat.


🙂

 

[GeneralVeers]

Punch in.

See 2 patients per hour (no saving the world).

Punch out (always on time).

Home.


Rinse, and repeat.


🙂

Exactly. I'd encourage everyone to try it for a week and see how they feel.

 

[RustedFox]

Exactly. I'd encourage everyone to try it for a week and see how they feel.

I'm sold.

I have one more shift tomorrow, then four days off. Then, I'll start. I encourage fellow readers/contributors on here to ask me in 10-14 days time just how it goes.

 

[WilcoWorld]

I agree with GV & BS. Except that I'd add that you've got to do right by yourself. Sometimes that means spending an extra 10 min (OK, 6 min) with a lonely grandma. Sometimes it means staying late. Whatever the case, you're doing it because it's what you, as the physician, feel is best. It's not because of some metric, some presumed perception, or something an admin who has never laid hands on a belly says.

If they don't like it, I know another job just down the road that would be happy to have me.

 

[joeDO2]

I used to buy into the physician respect attitude and used to resent the patients for it. It caused a lot of stress on my job and at home. Then I had an epiphany. I realized that if I act how the hospital admin and the large Contract Management Groups think of physicians, my life would get easier.

I realized that I am a replaceable cog in the machine. I am just a contractor required to a do a specific job for a specific number of hours. The patients are just "widgets" that I must move through the system during my scheduled hours. As a result I show up on time for my shift, move patients through my algorithm with the minimal amount of chitchat, stop seeing patients an hour before my shift and go home. I realized that there is no recognition anymore for going above and beyond, for staying after my shift, or for spending that extra 10 minutes comforting some lonely grandmother. It may sound depressing, but it's actually been a release. I don't stress about the hospital throughput issues which I can't control, and I go home on time, have a drink, and completely forget about anything work-related. The hospital doesn't want my services anymore? Great, there are hundreds of others looking for replaceable cog-physicians to move their widgets.

Sorry, maybe I'm being naive here as a student but I cannot accept that. I'm not sure what the solution is but we need to do better.

 

[GeneralVeers]

Sorry, maybe I'm being naive here as a student but I cannot accept that. I'm not sure what the solution is but we need to do better.

It's not about accepting or not accepting. This is how things are. If you pretend they are different you will be frustrated.

 

[The White Coat Investor]

Some people having a bad day here. Nothing to see. Move along. These are not the droids you're looking for.

If medicine is just moving widgets to you, go find a job you like better and do that. Life is too short to do a job you hate.

Or just cut back 3 shifts a month. You'd be surprised what a difference it makes.

 

[Hercules]

Or just cut back 3 shifts a month. You'd be surprised what a difference it makes.

This is amazingly true. Our group averaged 150-160 hrs/month when I got here 4 years ago. Now everyone is averaging 100-110. You'd be amazed how much happier everyone is and how much complaints in general have gone down.

 

[RustedFox]

This is amazingly true. Our group averaged 150-160 hrs/month when I got here 4 years ago. Now everyone is averaging 100-110. You'd be amazed how much happier everyone is and how much complaints in general have gone down.

I cant afford any less than 120 hours a month and "keep my health insurance" as part of my deal with my CMG. I presently average about 150.

Hmmm...

 

[Birdstrike]

Nothing to see. Move along. These are not the droids you're looking for.

C3PO? R2D2?

Wait, who are the droids we are looking for?

 

[KLPM]

Self-righteous student: "A bad doctor is one who exploits a patient's illness for financial gain."

Son, we are all exploiting sick people for financial gain. No wonder patients hate us so much. We make money off them being sick after all.

 

[Birdstrike]

Some people having a bad day here. Nothing to see. Move along. These are not the droids you're looking for.

If medicine is just moving widgets to you, go find a job you like better and do that. Life is too short to do a job you hate.

Or just cut back 3 shifts a month. You'd be surprised what a difference it makes.

In all seriousness though....

I won't condone treating patients like widgets, but isn't this what the system rewards? If your admin comes to you with a complaint of high wait times, and you respond with, "I was holding grandmas hand," will that be accepted?

Let's face it: "Customer Service" Medicine, rewards thee who moveth thy widgets the fastest.

I think the problem is "the system" and not the people forced to live in it. Some people are more accepting of the system I suppose, and others may fight it longer or ignore the mixed messages better. Also, I haven't read anyone on this thread saying they "hate" their job. I agree, though, life is much too short for that.

Also, agree that "working less" is the best current viable solution. However, with a shortage of BC/BE EPs, and an insistence to staff EDs to 15 min wait times, not based on how much the EPs want to work, it's not an option for many.

I'd type more, but I've got to go soak up some rays and hop in the pool.

 

[RustedFox]

In all seriousness though....

I won't condone treating patients like widgets, but isn't this what the system rewards? If your admin comes to you with a complaint of high wait times, and you respond with, "I was holding grandmas hand," will that be accepted?

I think the problem is "the system" and not the people responding to it. Some people are more accepting of the system I suppose, and others may fight it longer or ignore the mixed messages better. Also, I haven't read anyone on this thread saying they "hate" their job. I agree, though, life is much too short for that.

Also, agree that "working less" is the best current viable solution. However, with a shortage of BC/BE EPs, and an insistence to staff EDs to 15 min wait times, not based on how much the EPs want to work, it's not an option for many.

That's the exact issue; staffing. They want a 15 minute wait time, but won't staff adequately to achieve that goal. Instead... "the beatings will continue until morale improves."

Today is my last shift before a four-day stretch of off-time. When I return, its "WidgetWeek 2013". Stay tuned.

 

[Hercules]

That's the exact issue; staffing. They want a 15 minute wait time, but won't staff adequately to achieve that goal. Instead... "the beatings will continue until morale improves."

Today is my last shift before a four-day stretch of off-time. When I return, its "WidgetWeek 2013". Stay tuned.

This is yet another reason for us to seek SDGs so "they" becomes "we" and you can staff in the way that your group is comfortable. Don't forget though that over staffing is going to drop your effective hourly rate.

 

[RustedFox]

This is yet another reason for us to seek SDGs so "they" becomes "we" and you can staff in the way that your group is comfortable. Don't forget though that over staffing is going to drop your effective hourly rate.

Oh, trust me - I'd go SDG in a heartbeat, if I could find one around here. There are two large CMGs that are warring over the turf and shops frequently bounce between the two.

I'm also unwilling to live over 1 hour from A) an airport, and B) an NHL team.

That's just me.

 

[glorfindel]

What a cynical thread. What a cynical, accurate, realistic, level-headed thread. Sigh.

I fully agree with the global assessment that physicians (and almost everyone else) in our mechanistic, striving, narcissistic society aren't respected as they used to be.

The health-care "system" is a mechanistic one where there is no role for things like "respect", "kindness", and other non-monetizable squishy emotional things that can't be quantified, ranked, or billed for. But these are the very things that contribute most to that squishy non-quantifiable emotion of "respect" that patients still occasionally feel for physicians.

The health-care "industry" (I *love* that description) is constantly being reengineered to maximize outcomes that are not compatible with "respect." So if respect is a rare thing these days, it shouldn't surprise anyone.

That said, respect and respectable actions are just as important to actual people as they were in Marcus-Welbytime and there is no reason why each physician who laments the systemic absence of respect shouldn't ask herself whether they are acting in a way that is worthy of respect. Because that's the only thing any of us have any control over.

If I ask myself if I'm worthy of respect, as a functionary in this health care system, it's not surprising that if I say "yes", it's often because I do things that aren't acknowledged (much less rewarded) by this system.

-- true kindness to patients that has very little correlation with P-G satisfaction scores
-- a willingness to say "no" to absurd institutional imperatives even though I might make less money
-- the decision to fight the unpleasant battles with patients about narcs, or with administrators about useless metrics and benchmarks, or with consultants about unreasonable over testing, instead of deferring these battles to someone else on another day, and at the risk of pissing people off and getting threats about being fired or sued.

My point is, "respect" has to be earned, and it is only 50% in your power to obtain. You must act respectably (that's the part you can control), and someone else has to respect you for it (that's never going to be something you can control)

Never expect "respect" in general from the system, because it's not capable of respect. The only kind of respect you'll ever get is from particular people, and only because you've earned it.

 

[Arcan57]

Patients behave as both widgets and people. Sort of like light being both a particle and a wave. Forgetting their widget nature leads to pissed off admins, pissed off patients (everyone wants to be treated specially, except nobody wants the extra wait that comes from other people's special treatment), and in its most extreme examples, loss of employment. Forgetting the humanity of the patient leads to decreased satisfaction with patient interaction, decreased diagnostic accuracy, and less emotional investment in your work. In general, it's less psychically demanding to ignore the humanity and develop work-arounds to offset the negatives (ie fewer shifts, more testing to make up for decreased history, and rationalizing that you're just a cog) than it is to deal with the never ending adversives that come with ignoring the widget side.

 

[discharged]

America has become spoiled, with top notch health care available one phone call away. Partly, the fall of our superiority stems from the fact that there are "enough" physicians. I don't know if I buy into this "shortage" business, because in America, enough is synonymous to abundance. That, in turn, leads to us being replaceable "cogs".

As it was mentioned earlier, this is way, way bigger than any one of us. What else can you do

 

[la gringa]

Punch in.

See 2 patients per hour (no saving the world).

Punch out (always on time).

Home.


Rinse, and repeat.


🙂

i agree in theory - but in reference to GV's post above - it's the human part of medicine that keeps me sane at work. i can't just move people through the algorithm - heartfelt "thank you's" from patients NEVER get old. seeing a kiddo come in looking puny and leave smiling and running around the room NEVER gets old.

i am by no means someone who is naively happy or anything, but everywhere i have worked, the staff knows me as someone who always has a smile on my face. (see also: my multiple posts about h/o high PG scores). i genuinely do enjoy being a physician, with bursts of hating humanity.

i agree, however, in not letting the metrics BS get you down. you are ONE PERSON. do your best. don't dilly-dally and keep people moving as best as you can. don't be so fast that you're practicing dangerous medicine nor so slow that you're noticable as the "slow doc"... and you'll be ok.

 

[bulgethetwine]

Veers opined:

"I used to buy into the physician respect attitude and used to resent the patients for it. It caused a lot of stress on my job and at home. Then I had an epiphany. I realized that if I act how the hospital admin and the large Contract Management Groups think of physicians, my life would get easier.

I realized that I am a replaceable cog in the machine. I am just a contractor required to a do a specific job for a specific number of hours. The patients are just "widgets" that I must move through the system during my scheduled hours. As a result I show up on time for my shift, move patients through my algorithm with the minimal amount of chitchat, stop seeing patients an hour before my shift and go home. I realized that there is no recognition anymore for going above and beyond, for staying after my shift, or for spending that extra 10 minutes comforting some lonely grandmother. It may sound depressing, but it's actually been a release. I don't stress about the hospital throughput issues which I can't control, and I go home on time, have a drink, and completely forget about anything work-related. The hospital doesn't want my services anymore? Great, there are hundreds of others looking for replaceable cog-physicians to move their widgets."
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It's that attitude that contributes to the sickness. It might make Veers individually happy, but he's pissing in the rest of your pools.

Ironically, very happy practicing in Canada - make more money than I ever did in the States, have no Press Gainey, not nearly the mid-level encroachment, the population is generally smarter than the average U.S. cohort, and physician respect is high. I never have to ask the government how to practice (I have the same resources as I did in the U.S. and a whole lot more autonomy since I don't have as many know-it-all administrators and nursing supervisors dictating my practice) though people like Veers seek to demonize it every chance they get.

 

[ERDude]

i agree in theory - but in reference to GV's post above - it's the human part of medicine that keeps me sane at work. i can't just move people through the algorithm - heartfelt "thank you's" from patients NEVER get old. seeing a kiddo come in looking puny and leave smiling and running around the room NEVER gets old.

i am by no means someone who is naively happy or anything, but everywhere i have worked, the staff knows me as someone who always has a smile on my face. (see also: my multiple posts about h/o high PG scores). i genuinely do enjoy being a physician, with bursts of hating humanity.

i agree, however, in not letting the metrics BS get you down. you are ONE PERSON. do your best. don't dilly-dally and keep people moving as best as you can. don't be so fast that you're practicing dangerous medicine nor so slow that you're noticable as the "slow doc"... and you'll be ok.

Well put. I don't actually come on this forum as much anymore because the prevailing attitude seems so overly doom-and-gloom.

I mean, don't get me wrong, i realize that this is an appropriate place to vent, but if all you read is other ER docs bitching about how horrible the job is it get's really old, really fast.

Somedays the job sucks, somedays it is great, most days it just okay. But, I agree with La Gringa that those patient encounters where you really turn somebody around (think pyelo, renal colic, bad case of strep), make a legitimate save, or when the patient/family expresses genuine gratitude are very rewarding and a perk of this job that most people just don't get to experience.

I work in an inner-city hospital with a highly variable patient population but I would still say that the vast majority of my patient encounters are positive (meaning I give reasonably appropriate care and the patient is satisfied).

 

[WilcoWorld]

I think that a lot of GV's critics are misinterpreting the post. At least, you're interpreting it differently than I did when I agreed with it.

Too often pragmatism is misinterpreted as pessimism. This is especially true with respect to medicine.

If you expect that, as a physician, your job is to save the world, you will be disappointed by your results and angered by non-physicians putting obstacles in your way. This is a source of unnecessary suffering.

However, if you recognize that your job is a job, you'll recognize that your task is to take good care of a reasonable number of patients, and that at the end of the day you should go home and enjoy the rest of your life. This is liberating.

That does not mean that you must be uncaring and uncompassionate. It does not mean that you can't take joy in a good save or alleviation of suffering. It simply dictates that you recognize that that's not what they're paying you for.

In a nutshell: If you expect EM to be your source of self-worth and respect, you will be frustrated by the changing face of medicine. But if you expect EM to be a secure source of a nice income, you wont be disappointed.

 

[GeneralVeers]

That does not mean that you must be uncaring and uncompassionate. It does not mean that you can't take joy in a good save or alleviation of suffering. It simply dictates that you recognize that that's not what they're paying you for.

In a nutshell: If you expect EM to be your source of self-worth and respect, you will be frustrated by the changing face of medicine. But if you expect EM to be a secure source of a nice income, you wont be disappointed.

That's my point. You can do all the touch-squishy-feely stuff. If it makes you feel good, then do it. Just realize that at the end of the day you are not getting any recognition from anyone for doing it. The same goes for seeing 3 pts/hour to "help out" your colleagues, then picking up patients until the end of shift and staying 2 hours overtime to clean up. It may alleviate your own guilt and sense of duty, but it takes a lot more work and can make your home life more miserable. You also don't get anything for it in the end.

I'm paid to show up at a certain time, see 2.5 pts/hour, make sure I don't kill anyone, then go home on time. For me that's enough. I don't expect anyone to give me a "job well done", a pat on the back, a plaque, or anything else. I used to kill myself seeing tons of patients, staying overtime and trying to be Super-doc. I got no recognition for it, burned myself out doing it, and was increasingly frustrated in the job.

 

[RustedFox]

Day one of four-day "off-stretch" before WidgetWeek2013.

I have finished all of my outstanding charts (see my other thread if you want the story on this), and will proceed to play golf and watch baseball for the next 3 days.

Then, WidgetWeek begins.

 

[GeneralVeers]

Day one of four-day "off-stretch" before WidgetWeek2013.

I have finished all of my outstanding charts (see my other thread if you want the story on this), and will proceed to play golf and watch baseball for the next 3 days.

Then, WidgetWeek begins.

I look forward to hearing about it. I also recommend taking a few coffee breaks during your shifts, and at least 15-20 min lunch/dinner break where you actually leave the department. Trust me, it's still there when you get back.

 

[RustedFox]

I look forward to hearing about it. I also recommend taking a few coffee breaks during your shifts, and at least 15-20 min lunch/dinner break where you actually leave the department. Trust me, it's still there when you get back.

It'll get its own thread.

I read some of the posts above, and thought to myself for second today: "Naahh, I can't just go to work and be uncaring."

Then I got a phone call being hassled about my charts. Seriously.

Okay, then. Charts need to get done ? Patients gonna wait.

Haters gonna hate.

 

[RustedFox]

Odd you should mention: "Coffee breaks, and a dinner break."

Had the experience the other day where the MLP decided that, well... she was 'closed' to go on dinner break. Picked up the three charts yet to be seen in her rack, dumped them in mine, said - "I gotta go eat. Back soon."

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